Application of tip-flexible vacuum-assisted ureteral access sheath in flexible ureteroscopic laser lithotripsy for large renal stones(≥2 cm)
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摘要: 目的 输尿管软镜、软镜相关耗材及激光的改进让输尿管软镜碎石取石术的适应证不断扩展。本文将探讨头端可弯曲负压输尿管软镜鞘在输尿管软镜技术处理大负荷肾结石中的有效性和安全性。方法 回顾性分析2021年4月—2022年12月浙江大学医学院附属第一医院和浙江省新昌县中医院完成的55例≥2 cm肾结石手术患者的临床资料。所有患者均使用头端可弯曲负压输尿管鞘配合输尿管软镜下钬激光碎石取石。收集患者的基线特征、围手术期指标(清石率、手术时间、并发症发生率等)，并进行总结。结果 55例患者中，男44例，女11例，中位年龄56岁；平均结石长径(3.4±1.64) cm，平均CT值(1 179.8±270.1) HU；其中48例有下盏结石分布。46例患者经一期手术完成治疗，9例需行二期输尿管软镜碎石取石术。平均手术时间(120.8±94.7) min。术后发热1例。术后即刻清石率为58.2%，术后1个月清石率为87.3%。结论 对于大负荷肾结石，头端可弯曲负压输尿管鞘能让输尿管软镜碎石取石术安全且有效地进行，值得进一步推广应用。Abstract: Objective The improvement of flexible ureteroscopy, medical consumables and laser has revolutionized the management of upper urinary tract stones. We evaluated the efficacy and safety of tip-flexible vacuum-assisted ureteral access sheath in flexible ureteroscopic laser lithotripsy for large renal stones.Methods Clinical data of 55 patients with ≥2 cm renal stones between April 2021 and December 2022 were reviewed retrospectively. The flexible ureteroscopic laser lithotripsy procedures were performed with a novel tip-flexible vacuum-assisted ureteral access sheath. The baseline characteristics and perioperative data were summarized.Results There were 44 males and 11 females in our case series, with a median age of 56 years old. The mean calculi size was (3.4±1.64) cm and the mean calculi density measured by CT scan was (1 179.8±270.1) HU. Forty-eight cases were lower calyx involved. Forty-six cases were finished in single session, while 9 cases needed an additional session. The mean operative time was (120.8±94.7) min. One patient experienced postoperative fever. The stone-free rate was 58.2% immediately and 87.3% one month postoperatively.Conclusion Tip-flexible vacuum-assisted ureteral sheath is safe and effective in flexible ureteroscopic laser lithotripsy for large renal stones.
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Key words:
- urolithiasis /
- flexible ureteroscopy /
- ureter access sheath
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表 1 围手术期指标
例(%)，X±S 项目 例数 手术时间/min 即刻清石率 术后1个月清石率 多期手术 网篮使用 所有患者 55 120.8±94.7 32(58.2) 48(87.3) 9(16.4) 26(47.3) 结石长径 2~3 cm 32 76.3±31.61) 22(68.8) 32(100.0)1) 0 16(50.0) >3 cm 23 182.6±117.3 10(43.5) 16(69.6) 9(39.1) 10(43.5) 下盏结石分布 无 7 91.7±44.4 6(85.7) 7(100.0) 1(14.3) 1(14.3) 有 48 125.0±99.5 26(54.1) 41(85.4) 8(16.7) 25(52.1) 结石CT值 ≤1200 HU 25 109.1±84.3 15(60.0) 23(92.0) 3(12.0) 12(48.0) >1200 HU 30 130.5±103.0 17(56.7) 25(83.3) 6(20.0) 14(46.7) 与结石长径>3 cm比较，1)P < 0.05。 
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